Coronavirus: Not a question of IF but WHEN virus will spread in US, parents be ready for teleschooling: CDC

Ultimately CDC expects to see community spread in the US and it's a question of how many people in the country will have severe illness

                            Coronavirus: Not a question of IF but WHEN virus will spread in US, parents be ready for teleschooling: CDC
(AP Photo/Lee Jin-man)

Americans must be prepared for teleschooling, remote working, and massive disruptions to their everyday lives because it is no longer a question of IF, but WHEN community spread of the novel coronavirus will happen in the US, the Centers for Disease Control and Prevention (CDC) has warned.

“Today our containment strategies have been largely successful. As a result, we have very few cases in the US and no spread in the community. But if more and more countries experience community spread, successful containment at our borders becomes harder and harder. Ultimately, we expect we will see community spread in this country. It is not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Dr. Nancy Messonnier, Director of the  National Center for Immunization and Respiratory Diseases, CDC, said during a media briefing on Tuesday.

“We will maintain for as long as practical a dual approach, where we continue measures to contain this disease, but also employ strategies to minimize the impact on our communities,” she said.

Currently, there is no vaccine to protect against this new virus, and no medications to cure COVID-19. In these circumstances, said Dr. Messonnier, non-pharmaceutical interventions or NPIs will be the most important tools in the country’s response to this virus. 

These interventions are based on the document — 'Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017'. This document looks at what can be done at the individual and community levels during a pandemic when there is no vaccine or proven medical treatments for the disease. It draws from the findings of nearly 200 journal articles written between 1990 and 2016. 

Dr. Messonnier elaborated on what these measures would look like with reference to COVID-19. These include NPIs at three levels -- personal, community and environment. 

“We are looking at data since 2016 and adjusting our recommendations to the specific circumstances of COVID-19. The document provides a framework for our response strategy. Based on what is known now, we would implement these NPI measures in a very aggressive, proactive way, as we have been doing with our containment efforts,” she said. 

“There are three categories of NPIs: personal — which include personal protective measures you can take everyday and personal protective measures reserved for pandemics; community NPIs, which include social distancing measures designed to keep people who are sick away from others, school closures and dismissals; and environmental NPIs, which include surface cleaning measures,” said Dr. Messonnier.

A US military policeman and South Korean security person check visitors at the US Army base Camp Walker, in Daegu, South Korea (Kim Hyun-tae/Yonhap via AP)

NPIs routinely recommended for prevention of respiratory virus transmission such as seasonal influenza include everyday personal protective measures. These are preventive personal actions the CDC recommends all the time for influenza season — that is, stay home if you are sick, cover your cough, wash your hands.

There are also specific measures that are recommended during a pandemic regardless of the severity level.

Personal protective measures reserved for pandemics include voluntary home quarantine of household members — who have been exposed to someone they live with who is sick. 

Non-pharmaceutical interventions in the personal category as outlined in Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017 (Source: CDC)

The CDC explained that the community-level NPIs are practical measures that can help limit exposure by reducing face to face contact in community settings.

For schools, the options include dividing students into smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education.

For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options. 

On a larger scale, communities and cities may need to modify, postpone or cancel mass gatherings, said Dr. Messonnier.

For healthcare settings, this might include triaging patients differently, looking at how to increase telehealth services, and delaying elective surgery.

Non-pharmaceutical interventions at the community level as outlined in Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017 (Source: CDC)

Dr. Messonnier said that the implementation of environmental NPIs will require everyone to consistently clean frequently-touched surfaces and objects at home, at school, at work, and at large gatherings.

Local communities will need to make decisions about what NPIs to implement and when based on how severe transmission and disease is and what can be done locally. This will require flexibility and adaptations as the disease progresses and new information becomes available, she added.

Non-pharmaceutical interventions in the environment category as outlined in Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017 (Source: CDC)

“Some of these measures are better than none. But the maximum benefit occurs when the elements are layered upon each other. Some community-level interventions that may be most effective in reducing the spread of a new virus, like school closures, are also the most likely to be associated with unwanted consequences and further disruptions. Secondary consequences of some of these measures might include missed work and loss of income,” Dr. Messonnier.

“I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. But these are things that people need to start thinking about now,” she emphasized.

What these interventions look like at the community level will vary depending on local conditions. 

“What is appropriate for one community seeing local transmission won't necessarily be appropriate for a community where no local transmission has occurred. This parallel, proactive approach of containment and mitigation will delay the emergence of community spread in the US and while simultaneously reducing its multiple impacts,” she explained.

Dr. Messonnier also advised people to think about what they would do for childcare if schools or daycares are closed.

“I had a conversation with my family over breakfast this morning. And I told my children that while Ii didn't think that they were at risk right now, we as a family need to prepare for significant disruptions in our lives. You should ask your children’s school about their plans for school dismissals or closures, ask about plans for teleschools. I contacted my local school superintendent this morning with exactly those questions,” she said.

She further told Americans: “You should think about what you would do for child care if schools or daycare is closed. Is teleworking an option for you? Does your healthcare provider offer a telemedicine option? All of these questions can help you be better prepared for what might happen.”

The owner of Vegetarian Dim Sum House in New York's Chinatown, sits in his empty restaurant usually bustling with customers, in New York (AP Photo/Bebeto Matthews)

Dr. Messonnier assured that the CDC and other federal agencies have been practicing for this since the 2019 influenza pandemic. “In the last 2 years, CDC has engaged in 2 pandemic influenza exercises that have required us to prepare for a severe pandemic and just this past year, we had a whole lot of government exercise practicing similarly around a pandemic of influenza,” she said.

Officials said that the CDC is currently operationalizing all of its pandemic preparedness and response plans working on multiple fronts, including putting specific measures to prepare communities to respond to local transmission of the virus that causes COVID-19.

“I want to recognize that people are concerned about the situation. I would say rightfully so. I am concerned about his situation, CDC is concerned about this situation. Now is the time for businesses, hospitals communities, schools, and everyday people to begin preparing as well. Over the last few weeks, CDC has been on dozens of calls with different partners in health, retail, education, and business sectors in the hopes that employers begin planning to respond in a flexible way to varying levels of severity to be ready to refine their business response plans if needed,” said Dr. Messonnier. 

She added, “I also want to acknowledge the importance of uncertainty. During an outbreak with a new virus, there is a lot of uncertainty. Our guidance and advice are likely to be, in turn, fluid, subject to change as we learn more.”

The announcements come even as the global COVID-19 situation continues to rapidly evolve and expand. 

“There is a lot of news coverage on community spread in a few countries. This means COVID-19 cases are appearing without a known source of exposure. Locations that have reported community spread now include Hong Kong, Iran, Japan, Italy, Singapore, South Korea, Thailand, Taiwan. Community spread is often a trigger to begin implementing new strategies tailored to local circumstances to blunt the impact of disease and control the spread of the virus,” said Dr. Messonnier.

She said the fact that this virus has caused illness, including illness that results in death, and sustained person to person transmission is concerning.

“These factors meet two of the criteria for a pandemic. As community spread is detected in more and more countries, the world moves closer towards meeting the third criterion — the worldwide spread of the new virus,” added Dr. Messonnier.

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